This month on Thrive we are focusing on helping women and mothers with the LOVE pillar of the nutrition trifecta: SLEEPLOVEPOOP. Essentially, we’re going to be looking into how to use nutrition to show our body the love & respect it deserves. So, today I’d like to focus on a topic that is super important for all women, especially those who are in their child bearing years.

I’d like to talk about the importance of dietary FOLATE. I wish I had known this information when I was pregnant. It might have helped spare me from a miscarriage, the anxiety and baby blues I experienced after the birth of my girls.

To help us understand the science behind this issue, I’ve called on Dr. Benita Perch, an extremely well-respected Naturopathic Physician from the Integrated Medicine Institute (IMI) in Hong Kong. Dr. Perch has studied under Dr. Ben Lynch, a doctor who has been at the forefront of the research on folate vs folic acid within the context of a much bigger study on genetics & epigenetics.

Dr. Perch, thanks so much for your time and helping this community learn more about why folate is so important for all women – especially those looking to get pregnant. Let’s start with the basics.

Q: Can you tell us what is folate and how is it different from folic acid?

A: Basically folic acid is a synthetic version of the folate we find in food – predominantly raw, dark, leafy greens. As women, we are told about folic acid when are thinking of having children because to date, it has been the supplement of choice to prevent neural tube defects in children. However, in order for the body to use folic acid for the purpose of preventing neural tube defects and for all of its other multiple purposes which we will discuss later on, folic acid must undergo a number of transformations in the body in order to become the active form of folate we know as “L-5-MTHF”. These transformations require a number of factors, for example functioning enzymes, as well as available receptors and transporters. To add to this complexity, if one has a specific gene mutation called “MTHFR” then, one could run into a situation where folic acid is unusable by the body. As a result, the have a reduced ability to convert folic acid to the active form of folate L-5-MTHF.

Q: Just for the benefit of the readers, MTHFR stands for “methylene-tetrahydro-folate reductase”. The MTHFR gene produces the enzyme that is necessary for properly using folate or folic acid through a process called methylation. I just recently did some genetic testing that shows I have the MTHFR mutation. How common is this MTHFR genetic mutation?

A: As the research stands today it seems that about 70% of the women have the MTHFR mutation — and this percentage varies by culture and geographical area.

Q: That’s 2 out of 3 women. So, to me it seems like a sensible idea to err on the side of caution and recommend folate over folic acid to every woman who is looking to get pregnant or already so. Is that where the scientific data is leading us to?

A: Yes, absolutely. If we lived in a very clean environment with no stress, then the genetic mutation that makes us less efficient at converting folic acid into usable active folate wouldn’t matter so much. But when one is trying to get pregnant, living in a polluted city like Hong Kong and trying to manage quite a bit of stress – then our ability to convert folic acid to folate efficiently gets compromised — even in someone who has no MTHFR mutation.

Moreover, taking folic acid can carry some negative effects. Folic acid competes with activate folate which means that your body may not be able to bind the folate, resulting in less active folate being readily available. It can decrease natural killer cell activity so that immunity is suppressed. And it can mask a B12 deficiency (whereas folate does not).

So really – given that folate also serves to prevent neural birth defects, it makes much more sense to supplement a woman with folate.

Q: Can you tell us how taking the active form of folate (“methylfolate”) can help women prevent miscarriages?

A: Folate is extremely important for the creation of new cells because it’s needed to make DNA. Babies are 100% new cells. So within the first couple of weeks of pregnancy when the nervous system is being developed, the pregnant body uses a large amount of folate. If there isn’t enough folate available because you’re not eating enough folate-rich foods or you are not converting folic acid efficiently enough — then you don’t have enough folate for the baby’s development. As a result, the fetus is not viable and miscarriage ensues.

Q: Gosh. So really, for women who suffer from recurring miscarriages, part of the answer might lie in taking active folate instead of folic acid.

So, let’s take a step back and talk a little bit more about this process through which folic acid is converted to folate: methylation. Would you please explain – what is methylation and what role does it play in our body? Because methylation is not just an important process for pregnant women – it’s crucial for everyone. Is that right?

A: Absolutely. Methylation is a process that happens in everyone about a million times a second. From a biochemistry point of view — methylation is just the addition of a single carbon group with 3 hydrogens onto a compound. The end product of methylation cycle is to make SAM-e, which gives its single carbon group to over 250 enzymes in the body. Why is that important? Well, it turns on and off certain genes, i.e gene regulation. It processes the chemicals we produce inside & those we ingest or are exposed to externally. It builds neurotransmitters and metabolizes them. It processes hormones. It builds immune cells. It’s incredibly important for DNA synthesis and energy production. It’s responsible for making myelin sheath (the protective coating on nerves); it builds & maintains cell membranes. It also converts homocysteine into methionine, which the body needs for proper metabolism and muscle growth and detoxification. So, those with an MTHFR mutation may have trouble effectively eliminating toxins, such as excess cholesterol & heavy metals from the body.

Q: What health risks are associated with this mutation?

A: There are many health risks associate with this mutation and miscarriage is but one. In my practice and according to the research done to date, mothers with methylation issues are more like to have children with an increased risk of autism, ADHD & even Down Syndrome. This mutation is also associated with toxin accumulation because of an impaired ability to detox. As a result, one has a greater risk to accumulate heavy metals & estrogens from the body. There is an increased risk of cancer because of an impaired ability to repair DNA properly & detox. One could also have issues with energy creation at the mitochondrial level; an increased risk of cardiovascular disease because of an impaired ability to convert homocysteine to methionine. The list of possible health risks is almost endless unfortunately.

Q: Is there a link between poor methylation and depression or mood disorders?

A: Very much yes because methylation is important for creating and breaking down neurotransmitters. There is a gene called “COMT” that is responsible for breaking down dopamine and norepinephrine. If you have a COMT mutation that impairs this break down and you are highly stressed, then you could end up with raised dopamine levels, which essentially means you will become even more stressed out because your stress hormones don’t get broken down. In this instance, folate, magnesium and B6 are probably the most important nutrients with which to supplement.

Q: So, even regardless of this gene mutation, having a diet rich in these nutrients could be a good way to nutritionally support a new mother who is suffering from anxiety or baby blues because having a more efficient methylation process can help us create and break down the neurotransmitters we need to deal with stress.

How about fatigue. That’s a major issue, especially after having kids. We are so sleep deprived and we’re under so much stress juggling a million different things, including incredibly demanding careers. Can you talk to us a little about how stress & burnout can affect methylation?

A: Of course. Methylation is important to help to create and breakdown neurotransmitters like serotonin, dopamine & norepinephrine. So if you have any issues with MTHFR – you’re more likely to have an imbalance of these neurotransmitters, which affect mood — especially when you’re stressed. Because when you’re stressed, you need to methylate more. And if you have problems methylating, then those people often have problems falling asleep when they’re stressed, because they don’t have enough methyl groups to convert serotonin into melatonin.

Q: So Dr. Perch – I have to admit, when I first found out that I had the MTHFR mutation, I got really scared. I poured over the literature to understand if I was indeed doomed by my genes. But given my own journey with whole foods and nutrition, I was so relieved to read plenty of literature written by Dr Ben Lynch and others that nutrition can play a vital role in how our genes are actually expressed. In other words, the food we eat (and don’t eat) can help us overcome the limitations of our genetic mutations.

A: Methylation becomes a problem when we put pressure on our body to have to methylate. So the best way is to look at the person overall and balance and remove the stressors as much as possible. It’s important to address any issues of toxicity in the body, such as removing heavy metals. In Hong Kong, investing in a good air purifier is always good. Also, eating as much clean, organic food as possible; and reducing inflammatory foods such as gluten or any foods to which you are intolerant. From a supplementation perspective – homeopathy and adrenal supplementation support can really help. Ensuring that your B-complex or multivitamin has the active forms of B12 and B9 is also important (i.e. methylcobalamin and methylfolate, respectively). From a lifestyle perspective: yin exercises such as yoga, tai chi & meditation. And really – doing things that bring you joy.

THANK YOU so much Dr. Perch, for sharing your insights.

For all the women & mothers out there who need a folate boost to help them make a baby from scratch, sleep soundly, reduce anxiety, create energy, repair DNA, detoxify and boost their metabolism, here’s my favourite recipe!

Dressing: Soak 1 cup of cashews for an hour in warm water. Add 1 tspn chickpea miso (or regular miso of your choice); and the juice of ½ lemon. Mix and add water 1 tbsp at a time until you’ve reached your desired level of thickness for the sauce.